Healthcare Provider Details

I. General information

NPI: 1902140007
Provider Name (Legal Business Name): JASON THOMAS SPEAKS PHD, FNP-C, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 10/11/2025
Certification Date: 10/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 SPAANS DR STE C, D AND F
GALT CA
95632-8609
US

IV. Provider business mailing address

1191 MALCOLM DIXON RD
EL DORADO HILLS CA
95762-3821
US

V. Phone/Fax

Practice location:
  • Phone: 209-744-9909
  • Fax:
Mailing address:
  • Phone: 415-696-1696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number22258
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number22258
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number824970
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number22258
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number22258
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22258
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number22258
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: